tbuckley/cabot-search huggingface dataset:
Abstract P116: Racial/Ethnic and Nativity Differences in Cardiovascular Disease Mortality in the United States: Insights From the National Health Interview Survey 1999-2018
Authors: Ruth-Alma Turkson-Ocran, Oluwabunmi V Ogungbe, Nwakaego A Nmezi, Binu Koirala, Fredrick Larbi Kwapong, Emily Aidoo, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Background: Racial/ethnic disparities in cardiovascular disease (CVD) deaths continue to persist, despite advances in preventive strategies. Few studies have examined disparities in CVD deaths by nativity status (US- vs. foreign-born). Objective: To assess differences in CVD deaths by nativity status across racial/ethnic groups in the US. Methods: Using a cross-sectional design, we pooled data from 1999-2018 National Health Interview Survey, with linked death records through 2019. Outcome, cardiovascular related deaths (CVD &amp; CVA) was modelled, in years, as time from interview till year of death, or last date of follow-up (December 31, 2019). Nativity status was defined as US- or foreign-born. We used Cox proportional hazards regression to estimate differences in CVD deaths across racial/ethnic groups (White, Black, Asian, Indigenous American, and Hispanic adults) stratifying by nativity status. Models were sequentially adjusted for sociodemographic and CVD risk factors. Results: We included 172,896,665 adults (16% US-born, 84% foreign-born). During median 10 follow-up years, 3.41 CVD deaths /1,000person-years occurred. Among US-born adults, age-and sex-adjusted CVD death rates were 34% higher among Non-Hispanic Black adults (Hazard Ratio: 1.34; 95% CI, 1.29–1.39), 23% higher among Indigenous Americans (HR: 1.23; 95% CI, 1.00–1.52) compared to Non-Hispanic White adults [Table] . In the fully adjusted models, CVD death rates were 6% and 23% lower among Black (HR: 0.94 [95% CI, 0.89–0.99]) and Hispanic (HR: 0.77 [95% CI, 0.70–0.84]) adults. Compared to US-born White adults, CVD death was lower in foreign-born White (HR: 0.74; 95% CI, 0.66–0.82), Black (HR: 0.57; 95% CI, 0.45-0.73), Hispanic (HR: 0.55; 95% CI, 0.50–0.61), and Asian (HR: 0.61; 95% CI, 0.53–0.71) adults, respectively. Conclusions: Overall, CVD deaths were lower among foreign- than US-born adults. Although, there were some racial/ethnic differences in CVD deaths, we found evidence of persistent survival advantage among foreign-born adults.
Abstract P223: Estimated Health Benefits, Costs, and Cost-Effectiveness of Eliminating Industrial Trans-Fatty Acids in Nigeria
Authors: Matti Marklund, Leopold N Aminde, Mary N Wanjau, Boni M Ale, Adedayo E Ojo, Clementina E Okoro, Abimbola O Adegboye, J. Lennert Veerman, Jason HY Wu, Mark D Huffman, Dike B Ojji
Journal: Circulation (2023)

Objectives: To estimate the potential health gains, costs, and cost-effectiveness of a mandatory limit on industrial trans fatty acids (iTFA) in the Nigerian food supply. Methods: We used Markov cohort models to estimate the effect on ischemic heart disease (IHD) burden, costs, and cost-effectiveness of a mandatory iTFA-limit (≤2% of all fats) for foods in Nigeria. Data on demographics, IHD epidemiology, and trans-fatty acid intake were derived from the 2019 Global Burden of Disease Study. We calculated the IHD burden attributable to iTFA by comparing the current trans-fatty acid intake to counterfactual settings with complete elimination of iTFA intake. Policy implementation costs (including government costs for legislation and monitoring, and industry costs for product reformulation), avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and healthcare costs saved were estimated over 10 years and lifetime of the Nigerian population. Incremental cost-effectiveness ratios using net costs (i.e., implementation costs minus healthcare cost savings) and HALYs gained (both discounted at 3%) were used to assess cost-effectiveness. Results: Over the first 10 years, elimination of iTFA intake was estimated to prevent 9,996 (95% uncertainty interval: 8,870; 11,118): IHD deaths and 66,569 (58,862; 74,083) IHD events, and to save 90 million USD (78; 102) in total healthcare costs. The corresponding estimates over the lifetime were 259,934 (228,736; 290,191), 479,308 (95% UI: 420,472; 538,177), and ~518 (450; 587). Policy implementation costs (government plus industry) were estimated as 18 million USD (12; 25) over the first 10 years, and 27 million USD (20; 35) over the population lifetime. The intervention was estimated to be cost-saving. Findings were robust across several deterministic sensitivity analyses (Figure). Conclusions: Our findings support legislating a mandatory limit of iTFAs as a cost-saving strategy to avert substantial numbers of IHD events and deaths in Nigeria.
Abstract P357: Gender Disparities in Utilization of Statins in Patients With Cancer and Atherosclerotic Cardiovascular Disease: Results From Houston Methodist Learning Health System Outpatient Registry
Authors: Izza Shahid, Roshni Mandania, Rakesh Gullapelli, Eleonora Avenatti, Nihan Farooq, Jorge Carrasco Avila, Aayush Shah, Sherif F Nagueh, Maan Malahfji, Jenny Chang, Khurram Nasir
Journal: Circulation (2023)

Background: Gender disparities in utilization of statins have been reported across patients with cardiovascular disease, however these patterns remain unknown amongst cancer patients. We sought to evaluate gender differences in statin use amongst cancer patients with atherosclerotic cardiovascular disease (ASCVD) using data from a large US healthcare system. Methods: Houston Methodist Learning Health System Outpatient Registry was utilized to obtain data of adult population between 2016 to 2022. All patients with a cancer and ASCVD diagnosis listed on their problems list using the ICD-10 CM codes were included. Statin use and dose were identified in the database using ATC codes, and this information was recorded based on medication reconciliation reviews with patients at each clinical encounter. Multivariate logistic regression analysis and chi-square test were utilized to compare statin use between the two genders. Results: A total of 16,926 patients with cancer and ASCVD were included (41.6% women). Women with cancer and ASCVD reported lower statin use (63.9% vs 73.7%; p&lt;0.01) and lower high-intensity statin use (27.5% vs 37.2%; p&lt;0.01) compared with men. Women with cancer and ASCVD were also less likely to have LDL-C&lt;70mg/dL (25.8% vs 35.2%; p&lt;0.01) compared with men. Consistent results were observed even after adjusting for demographic and cardiovascular risk factors (any statin OR 0.68 [0.63, 0.72]; high-intensity statin OR 0.66 [0.61, 0.70]). These disparities persisted across age (&lt;65, ≥65 years) and racial/ethnic (NHW, Hispanics, NHB, Asian/Other) strata. Conclusion: Although statins can potentially ameliorate risk of adverse cardiovascular events in patients with cancer, significant gender disparities exist in utilization of statins among US patients with cancer and established ASCVD, with women less likely to have guideline defined goal of LDL&lt;70 mg/dL and receive any and high-intensity statin therapy across age and racial/ethnic subgroups.
Abstract P385: Comparison of Different Algorithms to Measure Adherence to Multiple Anti-Hypertensive Medications Using Administrative Claims Database
Authors: Donglan Zhang, Jianing Xu, Xianyan Chen, Daniel Hall
Journal: Circulation (2023)

Background: Adherence to antihypertensive medication is a key component of hypertension management. Insurance claims data provide an opportunity to examine and monitor patients’ adherence rate to prescribed medications. However, patients may take multiple drugs or drug classes simultaneously to control high blood pressure. Little is known regarding the differences between algorithms used to measure adherence to antihypertensive medications using claims database. Hypothesis: We hypothesize that different algorithms, number of drug classes and observation periods lead to different medication adherence estimates. Methods: Using the 2017-2019 IBM MarketScan Medicare supplement claims database, we conducted retrospective analysis of 107,194 insured members with hypertension diagnosis and were taking anti-hypertensive drugs (e.g., angiotensin II inhibitors, ACE inhibitors, Beta Blockers, Calcium Channel Blockers, Antihypertensive combinations, Alpha Blockers, Diuretics). We calculated medication adherence rates using the proportion of days covered (PDC) for 6 months and 12 months among polytherapy users who use more than one antihypertensive drug classes. Three PDC algorithms were used and compared, including (1) number of days covered by at least 1 antihypertensive medication class (“maximum”) in 6 months and 12 months; (2) number of days covered by all antihypertensive medication classes after they are prescribed in 6 months and 12 months (“minimum”); (3) the average number of days covered by each medication class measured separately in 6 months and 12 months (“average”). Results: The proportion of patients who took two, three, or four or more antihypertensive drug classes was 26.96%, 9.44%, and 3.21% for the 6-month observation period, and was 26.73%, 9.37%, and 3.21% for the 12-month observation period. The mean PDC estimate and standard deviation (SD) using the “maximum” algorithm was 89% (0.2) for 6-month and 88% (0.2) for 12-month observation period, respectively. The mean PDC estimate and SD using the “minimum” algorithm was 45% (0.33) and 45% (0.33) for 6- and 12-month observation period, respectively. And the mean PDC estimate and SD using the “average” algorithm was 68% (0.23) and 67% (0.23) for 6- and 12-month observation period, respectively. Conclusions: There is a lack of consensus on the algorithms to measure adherence to anti-hypertensive medications based on pharmacy claims data. The PDC estimates based on the “average” algorithm was less dependent on the number of antihypertensive drug classes, and the 6- and 12-month observation period did not significantly influence PDC estimates.
Abstract P631: Association Between Suboptimal Sleep Duration and Cardiovascular Disease Prevalence Among Asian Americans
Authors: Santhosh Nadarajah, Risa Akiba, Isabelle Maricar, Sanah Vohra, Armaan Jamal, Yuichiro Yano, Tali Elfassy, Malathi Srinivasan, Gloria Kim, Latha Palaniappan, Karina Kim, Eugene Yang
Journal: Circulation (2023)

Importance: Cardiovascular disease (CVD) risk and prevalence is widely varied among Asian Americans. The American Heart Association recently added healthy sleep to its metrics used to define ideal cardiovascular health. Little is known about the association between sleep and CVD prevalence among Asian subgroups. Hypothesis: The association between suboptimal sleep duration and CVD risk prevalence will differ by Asian American subgroup. Methods: We analyzed results from the National Health Interview Survey (2012-2018, N=234,126), a nationally representative sample. Participants (age&gt;40 years old) included 214,956 non-Hispanic Whites (NHWs), 3,043 Asian Indians, 3,993 Chinese, 4,719 Filipinos, and 7,603 other Asians. Suboptimal sleep was self-reported and defined as &lt;7 or &gt;9 hours. CVD was defined as self-reported stroke, heart attack, coronary artery disease, or angina. We used multivariable logistic regression models to ascertain the association. All analyses included complex survey design considerations. Results: Suboptimal sleep duration was associated with higher CVD prevalence for NHWs and all Asians, but in Asian subgroup stratified analyses, suboptimal sleep was only associated with higher CVD prevalence among Other Asians. Conclusions: Our results show heterogeneity in the association between sleep duration and CVD prevalence among Asian subgroups, however further research is needed to better understand these relationships.
Abstract P591: Prevalence and Prognosis Comparing the New vs. Old ACC/AHA/HFSA HF Stage Classification: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Lena M Mathews, Yume Nohara, Ning A Ding, Carla A Sueta, Anna Kucharska-Newton, Amil M Shah, Chiadi E Ndumele, Kuni Matsushita, Patricia Chang
Journal: Circulation (2023)

Introduction: New guidelines for the management of heart failure (HF) have now incorporated cardiac biomarkers in the definition of those in pre-clinical HF (Stage B). We sought to compare the prevalence and prognosis according to the new vs. old ACC/AHA/HFSA HF Stage classification using data from the ARIC study visit 5 (2011-2013). Methods: The “old” classification included Stage 0 (no HF risk factors), Stage A (at risk for HF; without structural heart disease or symptoms), Stage B (structural heart disease; without HF signs and symptoms), Stage C1 (current or previous HF symptoms without HF hospitalization); Stage C2 (current or previous HF symptoms with HF hospitalization); Stage D (marked HF symptoms interfering with daily life). The “new” HF Stage classification included elevated NT-proBNP and cardiac troponin as evidence of Stage B. We examined all-cause mortality over five years, using tKaplan Meier method and multivariable Cox models. Results: Among 5,004 participants (mean age 75.3 (SD 5.1) years, 57% women, 22% Black), 28% had diabetes, 74% had hypertension, and 15% had coronary artery disease. With the new HF Stage classification, the prevalence of Stage 0/A decreased from 58% (n=2,887) to 27% (n=1,334), and Stage B increased from 29% (n=1,468) to 60% (n=3,021). The prevalence of Stage C2 and C1 were 7.3% and 5.7%, respectively, regardless of the new or old classification (no individuals had Stage D), with corresponding 5-year cumulative mortality of 33% and 21%. The new classification using cardiac biomarkers newly identified individuals as Stage B with mortality risk similar to those who were originally in Stage B (5-y cumulative mortality 10% and 12%, respectively). This “reclassification” left individuals with lower mortality risk as Stage 0/A (5-year cumulative mortality 5% vs. 8% in the new vs. old classification). When we adjusted for potential confounders, individuals newly classified as Stage B had an elevated mortality compared to those with Stage 0/A (HR 1.32 [0.98-1.77]) but not as high as those in original Stage B (1.83 [1.36-2.45]). Conclusions: The new HF classification newly identified a large number of older adults as Stage B, and they indeed had elevated mortality than those who stayed in Stage 0/A. However, after accounting for potential confounders, individuals newly classified as Stage B had slightly lower mortality than those originally in Stage B. Our findings will guide clinicians as to how to interpret new HF classification in terms of prognosis.
Abstract P234: Associations Between Sedentary Time With Physical Activity and Sarcopenia in the Oldest-Old Adults: The Health, Aging and Body Composition (Health ABC) Study
Authors: Shivangi Bajpai, Eric M Eberl, Eric J Shiroma, Eleanor Simonsick, Amanda E Paluch
Journal: Circulation (2023)

The oldest-old adults (aged 80+ years) are most impacted by sarcopenia, a progressive loss of muscle mass, muscle strength, and physical performance. Physical activity (PA) can slow progression of sarcopenia. However, this population is highly sedentary due to physical limitations and comorbidities. Replacing sedentary time (ST) with light-intensity physical activity (LPA) or small amounts of moderate to vigorous activity (MVPA) may be beneficial and feasible. We hypothesized that replacing ST with LPA or MVPA would be associated with a lower likelihood of developing sarcopenia. Methods: We used cross-sectional data (n=155, age 88.3±2.6 years) collected at the year 16 visit (2012-2014). Participants wore a hip-worn ActiGraph GT3X+ during waking hours for 7 days. Physical behaviors were quantified as minutes per day (min/d) in ST (0-99 counts per minute, cpm), low LPA (100-759 cpm), High LPA (760-1040 cpm), and MVPA (1041+ cpm). We defined probable sarcopenia using hand-grip strength cut points (males &lt;27 kg; females &lt;16 kg). Logistic regression and isotemporal substitution models were used to calculate odds ratios (OR) and 95% confidence intervals (95% CIs). Isotemporal substitution estimated the hypothetical effect of substituting ST with one standard deviation (SD) of respective PA categories. Results: MVPA was associated with lower odds of probable sarcopenia in the single model (OR=0.50, 95% CI: 0.27-0.83) and partition model (OR=0.35, 95% CI:0.15-0.83). In the substitution model, replacing ST with 13 min/d (1 SD) of MVPA was significantly associated with lower odds of probable sarcopenia (OR = 0.35; 95% CI: 0.15 - 0.83). There were no significant associations with LPA (Table 1). Conclusion: Findings suggest that even a modest increment of time spent in MVPA could reduce the likelihood of developing sarcopenia. Alternatively, findings could reflect the impact of sarcopenia on capacity to engage in MVPA. Confirmation of the direction of the association will require examination of these relationships over time.
Abstract 67: Obesity Paradox of Cardiovascular Mortality in Older Adults: National Health Interview Survey 1997-2018
Authors: Yuling Chen, Binu Koirala, Yvonne Commodore-Mensah, Cheryl R Dennison Himmelfarb, Wu Ying
Journal: Circulation (2023)

Background: The optimal body mass index (BMI) for cardiovascular disease (CVD) prevention in older adults remains uncertain. We aimed to evaluate the relationship between BMI and CVD mortality and identify the nadirs for CVD mortality in older (≥65 years) and younger (&lt;65 years) individuals. Methods: We used data from the 1997 to 2018 National Health Interview Survey, linked to the National Death Index (NDI). We included adults aged 18 years and older with BMI and NDI follow-up data available. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association between BMI and CVD mortality. Fully adjusted models were stratified by age and controlled for baseline age, sex, race, income, education, marital status, diabetes, cancer, general health, physical activity, smoking, and alcohol status. Results: Among 490,037 adults, the mean(±SD) age was 47(18) years; 55% were female. During a median follow-up period of 11 years, 19,194 CVD deaths occurred. The associations between BMI and CVD mortality were J-shaped in adults aged ≥ 65 years and &lt; 65 years. The CVD mortality was minimized at a BMI of 26 kg/m 2 in adults aged ≥ 65 years and 22 kg/m 2 in those aged &lt; 65 years. In adults aged ≥ 65 years, being overweight was associated with a lower risk of CVD mortality (HR 0.93, [95% CI, 0.89-0.96]); having level I obesity (0.90 [0.94-1.05]) and level II obesity (1.06 [0.97-1.16]) did not increase the risk of CVD mortality; and level III obesity was associated with increased risk of CVD mortality in comparison with individuals who had a normal BMI ( Figure ). In individuals aged &lt; 65 years, being overweight, level I, II, and III obesity were associated with a progressively higher risk of CVD mortality. Conclusion: Overweight and level I obesity seem to be protective against CVD mortality in older adults. This obesity paradox suggests that the optimal BMI might be sensitive to age. Thus, weight management should be individualized.
Abstract P374: Perception of Short-Term and Lifetime Risk of Atrial Fibrillation: A Survey of American Heart Association Members
Authors: Favel L Mondesir, Alistair Thorpe, GerMya Bradley, Mellanie T Hills, Yvette Cozier, Darae Ko, Jelena Kornej, Steven A Lubitz, Christopher D Anderson, Emelia J Benjamin, Angela Fagerlin, Ludovic Trinquart
Journal: Circulation (2023)

Background: Physician communication of lifetime risk prediction can improve patient understanding of atrial fibrillation (AF) risk and motivate lifestyle changes and preventive measures. Therefore, our objective was to assess how physicians perceive short-term and lifetime risks of atrial fibrillation (AF), using a survey. Methods: We invited American Heart Association (AHA) members to complete an online survey via email from November 2-22, 2021. Respondents were randomized to one of 32 vignettes characterized by AF risk factors (height, weight, current smoking, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, history of heart failure, and history of myocardial infarction). Respondents were further randomized to either estimate the 5-year or lifetime AF risk on a 0-100% scale with 10% intervals (e.g., “10-19%”) or were shown the predicted 5-year or lifetime AF risk value and asked to pick the correct interpretation in a multiple-choice question. Results: Of 11,330 AHA professional members who received the emailed survey, 109 (1%) physicians responded (mean age 51 years, 33% women) (Table). Most respondents estimated the 5-year AF risk correctly (7/9, 78%) but none accurately estimated the lifetime risk (0/18, 0%). Most respondents interpreted the predicted 5-year risk correctly (21/28, 75%) but about half of respondents misinterpreted the lifetime risk (14/25, 56%). Conclusions: In a small sample of physicians, few respondents correctly estimated and interpreted the lifetime risk of AF, suggesting that physicians may not be familiar with this risk format. It may be necessary to study the frequency and manner in which physicians communicate lifetime risk of AF.
Abstract P255: Risk Factors for Incident Depressive Symptoms During the COVID-19 Pandemic Among Multi-Ethnic Older Adults: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Asma Sharaf
Journal: Circulation (2023)

Objectives: The COVID-19 pandemic has been associated with an increase in the prevalence of depression symptoms among young adults in the US. We examined the impact of the pandemic on the prevalence and incidence of depression symptoms, and related sociodemographic and cardiovascular risk factors, among older adults in a US general population-based sample. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) is a longitudinal cohort study that recruited participants who were 45-84 years old and without cardiovascular disease in 2000-02. Depression symptoms were assessed using the Center for Epidemiologic Studies depression scale (CES-D-10), during the pandemic (2021-2022) and pre- pandemic (2010-2011). We examined depressive symptoms in individuals with scores in both time periods. Incident depressive symptoms were defined as a CES-D-10 score ≥10 among participants with a CES-D-10 score &lt;10 on pre-pandemic assessment. Risk factors for increases in CES-D-10 score and incident depressive symptoms, were examined by linear and logistic regression, respectively, adjusting for socio-demographic factors, health behaviors, and clinical characteristics. Results: Pre-pandemic and pandemic era CES-D-10 measures were available in 1602 MESA participants with mean age 75 years including 895 (55 %) women, who self-reported race/ethnicity as Non-Hispanic White (42%), Chinese (15%), Black (22%), or Hispanic (21%). The prevalence of depressive symptoms was 13.6% during the pre-pandemic period and 15.8% during the pandemic, and there were 180 incident cases of depressive symptoms (13%). After adjustment, significant increases in CES-D-10 scores were observed in women (+1.2, P&lt;.001) and participants with lower education (less than high school versus college, +1.1, P=.03). Incident depressive symptoms were associated with female sex (aOR=2.16, p&lt;0.001) and current smoking (aOR=2.04, p=0.03). Incident depressive symptoms were modestly yet not significantly associated with moderate to severe COVID-19 infection (aOR=1.88, p=.06). We did not find hypertension or diabetes to be significantly associated with worsening or incident depression symptoms. Conclusions: The prevalence of depressive symptoms increased modestly during the COVID-19 pandemic, compared to assessments one decade earlier, in a sample of multi-ethnic older adults. Greater risk of incident or worsening depressive symptoms was observed in women and current smokers. Additional research is needed on how pandemic-era depressive symptoms could affect future cardiovascular health.